Citation Nr: A21020489 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 211001-188368 DATE: December 23, 2021 ORDER Service connection for headaches is denied. A disability rating in excess of 20 percent prior to January 11, 2021 and 40 percent thereafter for service-connected lumbar spine degenerative disc disease is denied. A disability rating in excess of 10 percent for service-connected radiculopathy of the left lower extremity is denied. A disability rating in excess of 10 percent prior to November 18, 2014 and in excess of 30 percent thereafter for service-connected cervical spine, segmental instability, cervical spinal stenosis is denied. A disability rating in excess of 30 percent for service-connected cervical radiculopathy, left upper extremity is denied. An earlier effective date of July 29, 2009, but no earlier, for the award of total disability rating based on individual unemployability due to service connection disability (TDIU) is granted, subject to the regulations governing the payment of monetary awards. An earlier effective date of July 29, 2009, but no earlier, for eligibility to Dependents' Educational Assistance (DEA) benefits under Chapter 35, Title 38 of the United States Code is granted, subject to the regulations governing the payment of monetary awards. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran has had, at any time during the appeal, a current diagnosis for headaches. 2. Prior to January 11, 2021, the Veteran's lumbar spine degenerative disc disease has been manifested by complaints of pain and objective evidence of limitation of lumbar motion with pain resulting in forward flexion of the thoracolumbar spine forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. After, January 11, 2021, the Veteran's lumbar spine degenerative disc disease has not been manifested by unfavorable ankylosis of the entire thoracolumbar spine; invertebral disc syndrome (IVDS) with incapacitating episodes having a total duration of at least six weeks during the past 12 months has also not been shown. 3. For the entire period on appeal, the radiculopathy of the left lower extremity has been manifested by, at worst, mild paralysis of the sciatic nerve. 4. Prior to November 18, 2014, the Veteran's cervical spine has not more nearly approximated forward flexion greater than 15 degrees but not greater than 30 degrees, combined range of motion of the cervical spine is not greater than 170 degrees, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Furthermore, the preponderance of the competent evidence of record does not support a finding of unfavorable ankylosis of the entire cervical spine nor IVDS causes incapacitating episodes having a total duration of at least four weeks but less than six weeks during a 12-month period on appeal. 5. The Veteran's cervical radiculopathy of the left upper extremity is manifest by no more than moderate incomplete paralysis of the minor extremity. 6. Resolving all reasonable doubt in his favor, the Veteran was unable to engage in substantially gainful employment due to his service-connected disabilities as of July 29, 2009. 7. The criteria for basic eligibility for DEA under Title 38, United States Code, Chapter 35, are met as of July 29, 2009. CONCLUSIONS OF LAW 1. The criteria for service connection for headaches have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for a disability rating in excess of 20 percent prior to January 11, 2021 and 40 percent thereafter for service-connected lumbar spine degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242-5237. 3. The criteria for a disability rating in excess of 10 percent for service-connected radiculopathy of the left lower extremity associated with lumbar spine degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520. 4. The criteria for a disability rating in excess of 10 percent prior to November 18, 2014 and in excess of 30 percent thereafter for service-connected cervical spine, segmental instability, cervical spinal stenosis (previously marginal spurs at neural foramina of C6-7 and C5-6, claimed as residual injury C5-6 secondary to auto accident) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242-5243. 5. The criteria for a disability rating in excess of 30 percent for service-connected cervical radiculopathy, left upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8513. 6. The criteria for an effective date of July 29, 2009, but no earlier, for the award of TDIU have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400, 4.16. 7. The criteria for assignment of an earlier effective date of July 29, 2009 but no earlier for the award of basic eligibility for DEA benefits have been met. 38 U.S.C. §§ 3501, 3510, 5113; 38 C.F.R. §§ 3.807 (a), 21.3021. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from July 1968 to July 1970. An April 2020 rating decision established basic eligibility to Dependents' Education Assistance (DEA) from February 19, 2010 and granted earlier effective date for individual unemployability effective February 19, 2010. In October 2020, the Regional Office (RO) issued a rating decision which continued the 30 percent disability rating for service-connected cervical radiculopathy of the left upper extremity and found entitlement to an evaluation greater than 10 percent for degenerative disc disease of the cervical spine prior to November 18, 2014 was not warranted and an evaluation greater than 30 percent for degenerative disc disease of the cervical spine from November 18, 2014 was not warranted. In January 2021, the RO issued a rating decision which denied service connection for headaches, continued the 10 percent disability rating for service-connected radiculopathy of the left lower extremity and increased the disability rating of service-connected lumbar spine degenerative disc disease from 10 percent to 20 percent effective August 13, 2014 and assigned a 40 percent rating effective January 11, 2021. See January 2021 rating decision. Thereafter, in May 2021, the Veteran filed a Decision Review Request: Higher-Level Review pertaining to the issues of earlier effective date for eligibility of Dependents' Educational Assistance (DEA) benefits prior to February 19, 2010 and earlier effective date for entitlement to a total disability rating based on individual unemployability (TDIU) prior to February 19, 2010. The Veteran's May 2021 request for Higher-Level Review pertaining to the issues of entitlement to an earlier effective date for DEA benefits and TDIU were then denied in the July 2021 rating decision. Then, in October 2021, the Veteran filed a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) pertaining to the issues of increased rating for cervical radiculopathy of the left upper extremity, increased rating for degenerative disc disease of the cervical spine prior to and since November 18, 2014, increased rating for radiculopathy of the left lower extremity, increased rating for lumbar spine degenerative disc disease prior to and since August 13, 2014, service connection for headaches, and entitlement to an earlier effective date for a TDIU prior to February 19, 2010 and DEA benefits prior to February 19, 2010. The Veteran's representative submitted arguments with the October 2021 Notice of Disagreement. The Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Service Connection Generally, to establish a right to compensation for a present disability a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). With any claim for service connection, it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The requirement that a current disability exists is satisfied if the claimant had a disability at the time his claim for VA disability compensation was filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Without a current diagnosis, there may be no service connection for the claimed condition. For veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as organic diseases of the nervous system (migraine headaches), are presumed to have been incurred in service if they manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to service connection for headaches is denied. During the June 2014 Board hearing, the Veteran testified that his cervical spine disability caused him to experienced headaches "all the time". The October 2014 Board decision interpreted that claim as a claim for service connection for headaches as secondary to his service-connected cervical spine disability. While post service treatment records in July 2018 show a single complaint of a headache, there are no records which support a finding of a medical diagnosis relating to headaches for the Veteran. See CAPRI. However, as indicated above, service connection requires medical evidence of a current disability and the Veteran's post service treatment records are silent for any current headache diagnoses. Significantly, an August 2020 VA examination found the Veteran did not have a diagnosis of headaches. The Veteran claimed his headaches were secondary to his service spine condition. However, the examiner noted his records were reviewed with no complaints of headaches voiced. The examiner highlighted the fact that most recent primary care physician note in March 2020 stated that pain from cervical stenosis was fairly well controlled with gabapentin with no complaints of headaches voiced. See August 2020 VA Examination. Thus, there is no competent evidence that the Veteran has a current diagnosis of headaches. The Board has specifically considered the Veteran's claim for service connection for headaches as secondary to his service-connected cervical spine disability. However, to the extent that the Veteran's general claim for service connection for this disorder implies that he has current diagnoses, the Board finds that he is not competent as a lay person to attest to such diagnoses. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Moreover, the Veteran's post military treatment records and VA examination report, as outlined above, weigh against his claim for service connection for headaches. Accordingly, the Board finds that the preponderance of the evidence is against a finding that the Veteran has a current headache disorder to support his claim for service connection. In the absence of proof of a current disability for which service connection may be granted, there is no valid claim. See Brammer, 3 Vet. App. at 225. Accordingly, the claim for service connection for headaches must be denied. Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities found in 38 C.F.R. Part 4. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id. (quoting 38 C.F.R. § 4.40). With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). An examiner must also attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). 2. Entitlement to a disability rating in excess of 20 percent prior to January 11, 2021 and 40 percent thereafter for service-connected lumbar spine degenerative disc disease The Veteran's service-connected lumbar spine degenerative disc disease is currently rated 20 percent disability prior to January 11, 2021 and 40 percent thereafter under Diagnostic Code 5242. Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) for Diagnostic Codes 5235 to 5243. Diagnostic Code 5237 is used in rating lumbosacral strain, Diagnostic Code 5242 is used in rating degenerative arthritis of the spine, and Diagnostic Code 5243 is used in rating intervertebral disc syndrome (IVDS) of the spine. 38 C.F.R. § 4.71a. The Veteran does not have a diagnosis of IVDS of the spine, and therefore, Diagnostic Code 5243 is not applicable. Under the General Rating Formula, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, a 10 percent rating will be assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent of more of height. 38 C.F.R. § 4.71a. A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. Normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. 38 C.F.R. § 4.71a. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. at Note(2); see also 38 C.F.R. § 4.71, Plate V. Fixation of a spinal segment in neutral position (zero degrees) represents favorable ankylosis. Unfavorable ankylosis is defined as a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in certain restricted movements or other symptoms which are not present herein. 38 C.F.R. § 4.71a, General Rating Formula, Note (5). Under the General Rating Formula, any associated objective neurologic abnormalities are separately rated under the appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). The Board notes that the General Rating Formula rating criteria was not affected by the February 7, 2021 amendments. A review of the relevant evidence shows the Veteran presented for a VA spine examination in April 2018. At that time, he was diagnosed with degenerative arthritis of the spine. He described flare-ups as sharp pulsating pains lasting an untimed length of time for which he takes medication, stretches, and rests. He also suffered functional loss in the form of limited yard work. Range of motion testing showed 45 degrees of forward flexion, 10 degrees of extension, 15 degrees of right lateral flexion, 10 degrees of left lateral flexion, 20 degrees of right lateral rotation and 15 degrees of left lateral rotation with functional loss including limited bending. Pain was noted on examination and caused functional loss. However, there was no evidence of pain with weight-bearing and there was no objective evidence of localized tenderness or pain on palpation of the joints. The Veteran was able to perform repetitive use testing and there was no additional loss of function. The examination was not conducted during a flare-up and the examiner was unable to say without mere speculation whether the Veteran's back would suffer additional loss due to pain, weakness, fatigability, or incoordination. The Veteran did exhibit muscle spasms that did not result in an abnormal gait or abnormal spinal contour but did not experience guarding. Muscle strength testing was normal, no atrophy was noted, reflexes were normal but he did have slightly decreased senses on the left foot. Straight leg raising test was negative. There was no ankylosis and no other neurologic abnormalities. The Veteran did not have a diagnosis of IVDS and no assistive device was used. Functionally, the Veteran was limited in bending, twisting, and crouching. There was evidence of pain on passive range of motion, there was no evidence of pain when the joint was used in non-weight bearing. See April 2018 VA examination. In January 2021, the Veteran was afforded another VA examination wherein he was diagnosed with lumbar spine condition/degenerative disc disease of the lumbar spine. The Veteran described the condition as worsening. Some days he was unable to get out of bed due to flare-ups of his spine. Pain also caused him functional loss. Range of motion testing showed 40 degrees of forward flexion, 10 degrees of extension, bilateral lateral flexion, and bilateral lateral rotation. Range of motion contributes to the functional loss in limitation of bending and lifting. Pain was noted on examination and caused functional loss with each motion. There was no evidence of pain with weight bearing and no localized tenderness or pain on palpation of the joint. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of functioning. However, the examiner opined pain would further limit the Veteran's functional ability to 30 degrees of forward flexion and 5 degrees of extension, bilateral lateral flexion, and bilateral lateral rotation. The Veteran did not have guarding or muscle spasms of the back and there were not additional factors contributing to the disability. Muscle strength testing was all normal and there was no muscle atrophy noted. Reflexes were also normal. Straight leg testing was negative and there were no signs of radiculopathy noted. The spine was also not ankylosed and there were no additional neurologic abnormalities. IVDS was also not diagnosed and no assistive device was used. Diagnostic testing showed no arthritis. Functionally, the Veteran was limited in bending, lifting, walking, and standing. There was no evidence of pain on non-weight bearing. See January 2021 VA examination. After reviewing the foregoing evidence, the Board finds that the preponderance of the evidence is in favor of the currently assigned 20 percent disability prior to January 11, 2021 and 40 percent thereafter. Importantly, VA treatment records for the period at issue do not show evidence of worsening in the Veteran's lumbar spine degenerative disc disease prior to his January 11, 2021 VA examination. Instead, evidence prior to January 11, 2021 reflected the Veteran's range of motion of his lumbar spine was limited to 45 degrees of forward flexion with pain and functional loss. Regarding limitation of motion, the objective findings for flexion do not show limitation to 30 degrees or less, even with consideration of the effects of pain. Moreover, there is not medical evidence to support finding favorable ankylosis of the entire thoracolumbar spine at any point in time. Rather, the clinical and reported findings more nearly approximate the criteria for a 20 percent rating. 38 C.F.R. § 4.7. However, the 40 percent disability rating effective January 11, 2021 contemplates forward flexion of the thoracolumbar spine of 30 degrees or less which was shown at the January 11, 2021 VA examination. A higher 50 percent rating is not warranted because the Veteran does not have unfavorable ankylosis of the entire thoracolumbar spine or a diagnosis of IVDS requiring incapacitating episodes having a total duration of at least six weeks during the past 12 months. The Board acknowledges the Veteran's lay reports of multiple lumbar symptoms resulting in functional loss due to pain and flare-ups resulting in an inability to get out of bed. Clinical findings confirm his lay statements regarding his symptoms shown on examinations including limitation of motion of the lumbar spine as well as flare-ups causing additional limitation of motion. Most notably, the January 2021 VA examiner opined that with consideration of the Veteran's descriptions of flare-ups, his flexion of the lumbar spine would be limited to 30 degrees of forward flexion and 5 degrees of extension, bilateral lateral flexion, and bilateral lateral rotation. The clinical evidence during the entire appeal period also confirms that the Veteran had pain on various range of motion of the thoracolumbar spine, as well as pain on flare-ups. In this regard, the medical evidence consistently showed lumbar spine pathology resulting in functional loss including that caused by pain on motion of the lumbar spine. However, notwithstanding the clear evidence of flare-ups with limited range of motion and functional loss, the Board is unable to conclude that there is a basis for a higher rating for unfavorable ankylosis of the entire thoracolumbar spine as the clinical records have consistently reported that there was no evidence of ankylosis, favorable or unfavorable. The Veteran's lumbar spine symptoms including functional loss and pain are contemplated by the 40 percent evaluation beginning on January 11, 2021. Further, the Veteran is separately service connected for the left lower extremity radiculopathy which has been shown on examination. There are no neurologic associated bowel or bladder or shown. In reaching this conclusion, the Board considered functional loss due to pain and weakness that causes additional disability beyond that which is reflected on range of motion measurements. 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board has considered the effects of weakened movement, excess fatigability, and incoordination. 38 C.F.R. § 4.45. Although the Board accepts the Veteran's assertions that his lumbar spine lumbar spine degenerative disc disease causes him to experience pain and impacts his ability to perform daily activities, the Board has taken this into account in its above discussion of range of motion. The rating schedule does not require a separate rating for pain itself. Spurgeon v. Brown, 10 Vet. App. 194 (1997). Furthermore, even when the Veteran's complaints of pain are considered, the Board concludes that the overall manifestations of his lumbar spine degenerative disc disease generally do not demonstrate a degree of functional loss to warrant higher ratings for the period on appeal. Notably, there was no evidence of guarding or muscle spasms and muscle strength testing was normal. The Veteran also did not have muscle atrophy and did not require an assistive device for ambulation. The evidence of record does not support a rating in excess of 20 percent prior to January 11, 2021 and 40 percent thereafter for service-connected lumbar spine degenerative disc disease. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 3. Entitlement to a disability rating in excess of 10 percent for service-connected radiculopathy of the left lower extremity associated with lumbar spine degenerative disc disease Service connection was granted for left lower extremity radiculopathy and assigned a 10 percent evaluation effective November 19, 2012 in an October 2013 rating decision. The Veteran seeks a higher disability rating. His left lower extremity radiculopathy is evaluated under 38 C.F.R. § 4.124a, Diagnostic Code 8520, for paralysis of the sciatic nerve. Diagnostic Code 8520 provides that mild incomplete paralysis is rated 10 percent disabling; moderate incomplete paralysis is rated 20 percent disabling; moderately severe incomplete paralysis is rated 40 percent disabling; and severe incomplete paralysis, with marked muscular atrophy, is rated 60 percent disabling. Complete paralysis of the sciatic nerve, the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost, is rated 80 percent disabling. 38 C.F.R. § 4.124a. The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. In applying the above law to the facts of the case, the Board finds that the Veteran's currently assigned rating closely approximate his disability picture for his left lower extremity radiculopathy. Increased disability rating is not warranted. The April 2018 VA examination showed radiculopathy as moderate in the left lower extremity for intermittent pain, paresthesias and numbness. However, the examiner concluded the overall severity of his left lower extremity radiculopathy was mild. See April 2018 VA examination. The most recent January 2021 VA examination of the lumbar spine showed no signs of radicular pain or symptoms due to radiculopathy. See January 2021 VA examination. VA and private treatment records show radiculopathy consistent with the description provided in the April 2018 VA examination. There is no evidence of worsening symptomatology. After reviewing the foregoing evidence, which includes the Veteran's descriptions of his disability, the Board finds that the radiculopathy of the left lower extremity to be best characterized by mild symptoms. This finding is consistent with a 10 percent disability rating. Notably, recent evidence shows some improvement in the condition, however, the Board will not disrupt the currently assigned rating. In that vein, there is no evidence to suggest that at any point during the appeal period the Veteran's left lower extremity radiculopathy has risen to the level of moderate incomplete paralysis. In sum, the criteria for a disability rating in excess of 10 percent for left lower extremity radiculopathy have not been met and the claim for increased initial disability ratings is denied. The preponderance of the evidence is against the assignment of a higher disability rating. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Entitlement to a disability rating in excess of 10 percent prior to November 18, 2014 and in excess of 30 percent thereafter for service-connected cervical spine, segmental instability, cervical spinal stenosis The Veteran's cervical spine, segmental instability, cervical spinal stenosis is rated 10 percent prior to November 18, 2014 and 30 percent thereafter under Diagnostic Code 5242-5243. Cervical spine disabilities are rated under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome (IVDS) based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.71a. Under the General Rating Formula for Diseases or Injuries of the Spine, a 10 percent evaluation is warranted with forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees, muscle spasm, guarding, localized tenderness not resulting in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis is present, or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is warranted with forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, combined range of motion of the cervical spine is not greater than 170 degrees, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis is present. A 30 percent evaluation is warranted if forward flexion of the cervical spine is 15 degrees or less or there is favorable ankylosis of the entire cervical spine. A 40 percent evaluation is warranted if there is unfavorable ankylosis of the entire cervical spine. A 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Disease and Injuries of the Spine. Normal ranges of motion of the cervical spine are flexion from 0 to 45 degrees, extension from 0 to 45 degrees, lateral flexion from 0 to 45 degrees, and lateral rotation from 0 to 80 degrees. 38 C.F.R. § 4.71, Plate V. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least one week but less than two weeks during a 12-month period on appeal. A 20 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least two weeks but less than four weeks during a 12-month period on appeal. A 40 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least four weeks but less than six weeks during a 12-month period on appeal. A 60 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least six weeks during a 12-month period on appeal. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note (1). A November 2009 statement made by the Veteran reported limited movement and pain in his cervical area. See Statement in Support of the Claim. A January 2010 VA physical examination showed the Veteran walked with a normal gait using no assistive devices. His cervical spine showed normal curvature and posture. There was no tenderness to palpation of the spine or paraspinal processes and no spasms were palpated. Range of motion of the cervical spine showed forward flexion of 45 degrees with pain at 45 degrees. He could extent to 20 degrees with pain, left lateral flexion to 15 degrees with pain and right lateral flexion to 45 degrees with pain. The examiner noted no functional loss with any movement. Strength in the right upper extremity was normal and left upper extremity strength in the flexors and extensors were 4/5. Grip strength was diminished at 2/5. Sensation was decreased in the left upper extremity in all planes. There was no atrophy of the muscles, no additional limitation by pain, fatigue, weakness or lack of endurance following repetitive use. See January 2010 VA examination. VA treatment records from February 2014 reported limited range of motion in the cervical spine to the left side. He took Naproxen, Tylenol, and gabapentin to help with the daily neck pain. See CAPRI. In November 2014, the Veteran underwent a VA examination for his cervical spine. He was diagnosed with degenerative arthritis of the spine and segmental instability as well as cervical spinal stenosis. He reported he did not experience flare-ups of his cervical spine. Range of motion testing showed 10 degrees of forward flexion with pain, 10 degrees of extension with pain, 5 degrees of bilateral lateral flexion with pain and 15 degrees of right lateral rotation with pain and 10 degrees of left lateral rotation with pain. The Veteran was in too much pain to perform repetitive-use testing with 3 repetitions. The examiner noted the Veteran would have less movement than normal weakened movement as well as pain on movement. The Veteran did not have localized tenderness or pain to palpation for joints/soft tissue of the cervical spine, nor did he suffer muscle spasms of the cervical spine resulting from abnormal gait or spinal contour. However, he did have muscle spasms of the cervical spine which did not result in abnormal spinal contour and guarding of the cervical spine not resulting in abnormal gait or abnormal spinal contour. Muscle strength testing was slightly diminished but he did not have any muscle atrophy. Moreover, his reflex examinations showed normal reflexes but slightly decreased senses. There was no ankylosis present and the Veteran did not suffer from any other neurologic abnormality. A diagnosis of IVDS of the cervical spine was given and the Veteran suffered from incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. No assistive device was used and functionally, the Veteran had stopped working in 2008 due to his chronic neck pain and the positions he had to place his body working on computer cables. See November 2014 VA examination. A private independent medical examination dated January 2016 (scanned into the record in February 2016) provided a review of the Veteran's medical history. Pertaining to his cervical spine, the doctor reported the Veteran's pain in his cervical area is constant and when it started to increase it felt as if his entire cervical spine ached. The pain can come on in the absence of any real increase in activity. He stated that the pain can start to escalate simply while walking, laying down, or watching TV. When the pain escalated to his cervical region, it will extend down to the intrascapular area. The examiner highlighted the fact that the Veteran had little movement in his cervical spine without pain (unfavorable ankylosis of almost all of the Veteran's spine). Moreover, functionally, he did not have normal excursion, strength, speed, coordination or endurance in any direction. See January 2016 Private Medical Examination. Another VA examination was performed in April 2018 on the Veteran's cervical spine. The examiner diagnosed the Veteran with degenerative arthritis of the spine. At the examination, the Veteran reported he suffered from flare-ups of the cervical spine which were full to sharp shooting pains that radiated up and down his neck which could last hours to days for which he took Tylenol, Gabapentin and Naproxen and also performed stretching exercises. The Veteran reported functional loss including limited lifting and turning. Range of motion testing showed forward flexion of 15 degrees, extension of 5 degrees, bilateral lateral flexion of 10 degrees, right lateral rotation of 15 degrees and left lateral rotation to 30 degrees. Pain was noted on examination and caused functional loss. Additionally, the range of motion itself contributed to a functional loss in that it limited looking up and over his shoulders. Evidence of pain with weight bearing was noted on examination but there was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the cervical spine. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of function or range of motion after three repetitions. The examination was not performed during a flare-up, and the examiner noted the Veteran's neck was not examined during the flare-up so an opinion regarding functional loss due to pain, weakness, fatigability, or incoordination could not be given. Additionally, the examiner found no evidence of guarding or muscle spasms of the cervical spine. Slightly diminished muscle strength was noted but there was no evidence of muscle atrophy. There was no evidence of ankylosis or other neurologic abnormalities. The Veteran did have a diagnosis of IVDS but had not had any episodes of acute signs or symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. No assistive device was used and functionally, the examiner noted the Veteran was limited with lifting and overhead work. Finally, there was no evidence of pain on passive range of motion testing and no evidence of pain when the joint was used in non-weight bearing. See April 2018 VA examination. Additionally, the April 2018 VA examiner was asked to address the January 2016 private examiner's findings regarding the unfavorable ankylosis of the Veteran's cervical spine. The examiner reported: unfavorable ankylosis of the spine means that the posture of the individual is in an unnatural position. The radiology report for a cervical spine x-ray dated April 11, 2018 states that his cervical spine alignment was normal which would not be consistent with an unfavorable ankylosis. The examiner also defined ankylosis and provided examples of ankylosis within his rationale that the Veteran did not have ankylosis of his cervical spine, either favorable or unfavorable. Lastly, the examiner clarified that the cervical spine x-ray of April 11, 2018 showed cervical spondylosis, a form of osteoarthritis, but no bridging osteophytes. The April 2018 VA examiner also opined the Veteran does have IVDS of his cervical spine but not his thoracolumbar spine. He had not had any physician ordered bedrest within the past year. The examiner's opinion was based on his x-ray findings, radicular symptoms and findings of reduced strength and diminished reflexes on physician testing. See April 2018 VA examination. After carefully reviewing the evidence of record, the Board finds that the Veteran's cervical spine, segmental instability, cervical spinal stenosis does not meet the criteria for a rating in excess of 10 percent prior to November 18, 2014 and 30 percent thereafter. Specifically, prior to November 18, 2014, the Veteran's range of motion was not seen as worse than 45 degrees flexion. With consideration of painful motion, the Veteran's cervical spine is correctly assigned a 10 percent disability rating. Without evidence of forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, combined range of motion of the cervical spine is not greater than 170 degrees, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, a rating of 20 percent is not warranted prior to November 18, 2014. As of November 18, 2014, the record shows the Veteran's forward flexion worsened to 10 degrees of flexion in order to warrant a disability rating of 30 percent. However, the most probative evidence of record shows the Veteran does not have unfavorable ankylosis of the entire cervical spine at any point during the Veteran's appeal nor is there evidence of IVDS which caused incapacitating episodes having a total duration of at least four weeks but less than six weeks during a 12-month period. In fact, the April 2018 VA examiner specifically addressed both of these issues in finding there was no evidence of unfavorable ankylosis at any point during the period on appeal, despite the private examiner's reports of such. Furthermore, while the Veteran has a diagnosis of IVDS, the record does not support him suffering from incapacitating episodes having a total duration of at least four weeks but less than six weeks during a 12-month period. Therefore, the Board finds a rating in excess of 30 percent for the period beginning on November 18, 2014 is not warranted. In so finding, the Board acknowledges the January 2016 private medical examiner's findings contradict the findings of the April 2018 VA examiner. However, the Board finds the April 2018 VA examiner's medical opinions warrant more probative weight. Here, the January 2016 examiner's opinions were based solely on a review of the available medical records, whereas the April 2018 VA examiner reviewed both the medical record as well as personally examined the Veteran. Furthermore, the VA examiner provided thorough rationale for the medical opinions presented. Therefore, while the Board has considered the findings of the January 2016 private medical examiner, the Board finds that more probative weight is assigned to the April 2018 VA examiner's medical opinions. In reaching this conclusion, the Board considered functional loss due to pain and weakness that causes additional disability beyond that which is reflected on range of motion measurements. 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board has considered the effects of weakened movement, excess fatigability, and incoordination. 38 C.F.R. § 4.45. Although the Board accepts the Veteran's assertions that his cervical spine, segmental instability, cervical spinal stenosis causes him to experience pain and impacts his ability to perform daily activities, the Board has taken this into account in its above discussion of range of motion. The rating schedule does not require a separate rating for pain itself. Spurgeon v. Brown, 10 Vet. App. 194 (1997). Furthermore, even when the Veteran's complaints of pain are considered, the Board concludes that the overall manifestations of his cervical spine, segmental instability, cervical spinal stenosis generally do not demonstrate a degree of functional loss to warrant higher ratings for the period on appeal. Based on the foregoing, the Board finds that the preponderance of the competent evidence of record does not support a disability rating in excess of 10 percent prior to November 18, 2014 and in excess of 30 percent thereafter for service-connected cervical spine, segmental instability, cervical spinal stenosis. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, supra. 5. Evaluation of cervical radiculopathy, left upper extremity, which is currently 30 percent disabling, is continued. The October 2020 rating decision continued the Veteran's 30 percent disability rating for service-connected cervical radiculopathy of the left upper extremity. The Veteran contends that his left upper extremity cervical radiculopathy is more disabling then currently evaluated. The Veteran is rated under Diagnostic Code 8513 for paralysis of all the radicular nerves. Paralysis of the radicular nerve group is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8513. Under these criteria, mild incomplete paralysis is rated as 20 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 40 percent for the major extremity and 30 percent for the minor extremity. Severe incomplete paralysis is rated as 80 percent for the major extremity and 60 percent for the minor extremity. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). A January 2010 VA examination characterized the Veteran's left upper extremity radiculopathy as moderate. On examination, strength flexors and extensors were 4/5, grip strength was 2/5, and sensation was slightly decreased. See January 2010 VA examination. An April 2013 VA examination diagnosed the Veteran with peripheral neuropathy of the left upper extremity. Severe pain, severe paresthesias and/or dysesthesias and moderate numbness were noted in the left upper extremity. Diminished muscle strength, reflexes and senses was shown on the left side. Overall, the examiner found the Veteran suffered from mild incomplete paralysis of the ulnar nerve and mild incomplete paralysis of the sciatic nerve. See April 2013 VA examination. The November 2014 VA examination showed the Veteran had signs and symptoms of radiculopathy involving the upper, middle, and lower radicular groups. The examiner noted moderate paresthesias and/or dysesthesias and moderate numbness of the left upper extremity. However, the examiner concluded the overall severity of the radiculopathy was severe on the left side. See November 2014 VA examination. The January 2016 independent medical examination (scanned into the record in February 2016) highlighted the Veteran's pain radiating from his cervical area all the way to the fingers of his left hand. The pain was present every day but it was intermittent throughout his waking hours. He described the pain as sharp in nature. Additionally, the Veteran reported there was always some numbness in his left upper extremity and he suffered from a weakened left-hand grip. Lastly, the examiner characterized the Veteran's radicular symptoms as severe. See January 2016 Private Medical Opinion. An April 2018 VA examination diagnosed the Veteran with cervical radiculopathy. The examiner indicated the Veteran is right hand dominant. Symptoms attributable to his peripheral nerve conditions included moderate intermittent pain, moderate paresthesias and/or dysesthesias as well as moderate numbness in the left upper extremity. Some diminished muscle strength was shown in the left elbow flexion, left elbow extension, wrist flexion, and grip. However, no muscle atrophy was noted. He had a hypoactive left bicep and brachioradialis as well as some decreased sensation. No trophic changes were noted and the Veteran's gait was normal. Additionally, there were no special tests performed for median nerve. Incomplete paralysis was noted in the left upper radicular group (5th and 6th cervical). The examiner concluded the Veteran's left upper radicular group showed mild incomplete paralysis, middle radicular group showed moderate incomplete paralysis and lower radicular group showed moderate incomplete paralysis. The sciatic nerve also showed mild incomplete paralysis. The Veteran did not use an assistive device, but functional impairment was described as limiting lifting and grasping with the left hand. See April 2018 VA examination. Notably, the Veteran's VA and private treatment records during the period at issue show continuous complaints of left upper extremity weakness and numbness. In a November 2013 VA treatment record the Veteran reported an inability to grasp objects with his left hand and if he did, he would easily drop them. His medication was increased. Thereafter, an August 2013 notation characterized mild cervical radiculopathy. See CAPRI. Based on the above, the Board finds that the service-connected disability of left upper extremity cervical radiculopathy was primarily manifested by moderate pain, paresthesias and/or dysesthesias as well as numbness with some diminished muscle strength. While there is evidence suggestive of severe nerve damage in the November 2014 VA examination, the moderate paresthesias and/or dysesthesias and moderate numbness of the left upper extremity was actually noted. Furthermore, the Board acknowledges the conclusions of the 2016 private medical examiner, however, as previously discussed, the examiner was based on a review of medical records alone and did not include an examination of the Veteran. Therefore, the Board gives more probative weight to the findings of the VA examiners, including the most recent 2018 VA examination which concluded the Veteran's left upper extremity cervical radiculopathy was moderate in severity. Without a preponderance of the evidence suggesting the Veteran's disability is severe, the Board finds a rating in excess of 30 percent for his left upper extremity cervical radiculopathy is not warranted. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves and a separate or higher rating under a different Diagnostic Code would constitute pyramiding as there is no demonstration of separate disability arising from impairment of the ulnar or median nerves that has not been considered under the more generalized impairment of all of the radicular groups under Code 8513. As such, separate ratings are not warranted. 38 C.F.R. §§ 4.14, 4.25; Esteban 6 Vet. App. at 259. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a rating in excess of 30 percent for left upper extremity cervical radiculopathy. In denying higher ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 6. Entitlement to an effective date prior to February 19, 2010 for TDIU Procedurally, an August 2016 rating decision granted entitlement to TDIU effective November 13, 2014 and granted basic eligibility to DEA from November 13, 2014. See Rating Decision. Thereafter, a February 2017 rating decision granted entitlement to an earlier effective date for the grant of individual unemployability with an effective date of November 19, 2012 as well as an earlier effective date for the grant of eligibility to DEA with an effective date of November 19, 2012. See Rating Decision. Lastly, in March 2020, the RO granted entitlement to TDIU on an extra-schedular basis from February 19, 2010, the date of the Veteran's claim for TDIU. See VA Memo and see Rating Decision. The Veteran seeks entitlement to an effective date of July 27, 2009 for the award of a TDIU. He contends that this is the date of his increased rating claim for a cervical spine disability. The July 14, 2010 rating decision granted the Veteran entitlement to an increased rating for his cervical radiculopathy of the left upper extremity effective July 27, 2009 while deferring a decision on TDIU, which was raised as part and parcel to the increased rating claim. The Veteran has continuously appealed the claim for entitlement to a TDIU. Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that the Veteran meets the schedular requirements. If there is only one service-connected disability, this disability should be rated at 60 percent or more; if there are two or more disabilities, at least one should be rated at 40 percent or more with sufficient additional service-connected disability to bring the combination to 70 percent or more. 38 C.F.R. § 4.16. A claim for a TDIU is considered a claim for an increase. In assigning effective dates for increases, except as provided in paragraph §3.400(o)(2) and § 3.401(b), the effective date is date of receipt of claim or date entitlement arose, whichever is later. As an exception to this general rule, §3.400(o)(2) provides that the effective date is the earliest date of which it is factually ascertainable based on all evidence of record that an increase in disability had occurred if a complete claim or intent to file a claim is received within one year from such date; otherwise, the effective date is the date of claim. Id. Here, the record shows the Veteran was service connected for cervical spine degenerative disc disease and cervical radiculopathy of the left upper extremity with a combined disability rating of 40 percent from July 27, 2009 and 50 percent from November 9, 2009, when he was additional service connected for PTSD, lumbar spine degenerative disc disease and left wrist osteoarthritis. Based on his combined disability ratings, the Veteran did not meet the criteria set forth in 38 C.F.R. § 4.16 prior to November 2014. However, a March 2020 VA advisory opinion determined that TDIU was warranted on an extra-schedular basis effective February 19, 2010, the date the claim for TDIU was received. See VA Memo. The advisory opinion was based on the Veteran's lay testimony that his neck and back, combined with difficulties with dexterity and repetitive use of the left hand caused by radiculopathy and arthritis of the left wrist cause him difficulties with employment that ultimately rendered him eligible for TDIU on an extra-schedular basis as of the date of the claim for the benefit. Although the RO based its assigned effective date on the date the Veteran formally filed for TDIU, the Board notes that on July 27, 2009, the Veteran filed a claim for an increased rating for his service-connected cervical spine disability. The July 14, 2010 rating decision granted a 30 percent disability rating for cervical radiculopathy effective July 27, 2009 while deferred the claim for TDIU, which was raised part and parcel to the increased rating claim. The Veteran has continuously appealed the claim for entitlement to TDIU since the July 27, 2009 claim. Thus, resolving any reasonable doubt in the Veteran's favor, the Board finds that a TDIU was raised as part of his July 2009 claim. Turning to the Veteran's eligibility, the Board notes the Veteran's VA Form 21-8940 reported the Veteran became too disabled to work as of January 2009. Moreover, the March 2020 advisory opinion was based on the Veteran's lay testimony that his neck and back, combined with difficulties with dexterity and repetitive use of the left hand caused by radiculopathy and arthritis of the left wrist cause him difficulties with employment that ultimately rendered him eligible for TDIU on an extra-schedular basis as of the date of the claim for the benefit. Therefore, resolving any reasonable doubt in the Veteran's favor, the Board finds that a TDIU was raised as part of the Veteran's July 27, 2009 claim and that the evidence shows he was unable to maintain substantially gainful employment from July 27, 2009, due to his service-connected disabilities. As such, an earlier effective date for TDIU is granted, from that date. 7. Entitlement to an effective date prior to February 19, 2020 for eligibility to DEA The Veteran seeks an earlier effective date for DEA benefits pursuant to 35, Title 38 of the United States Code. The Veteran was awarded eligibility to DEA in an April 2020 rating decision, effective February 19, 2010, based upon the RO's finding that he was permanently unable, as of that date, to secure or follow a substantially gainful occupation due to his service-connected disabilities. (Continued on the next page) Except as provided in subsections (b) and (c), effective dates relating to awards under Chapter 35 shall, to the extent feasible, correspond to effective dates relating to awards of disability compensation. 38 U.S.C. § 5113. As explained above, the Board has found that the appropriate effective date of the Veteran's TDIU is July 27, 2009. Since the effective date for DEA benefits in this case is directly related to a finding that the Veteran had a total disability that was permanent in nature by virtue of his TDIU rating, the Board finds that an effective date of July 29, 2009, for Chapter 35 benefits is warranted. Robert A. Elliott II Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Churchwell, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.